Provider Demographics
NPI:1134658156
Name:OBIOMA, DANIEL U
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:U
Last Name:OBIOMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 COUNTRY CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3112
Mailing Address - Country:US
Mailing Address - Phone:404-317-9134
Mailing Address - Fax:708-801-5921
Practice Address - Street 1:1150 COUNTRY CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3112
Practice Address - Country:US
Practice Address - Phone:404-317-9134
Practice Address - Fax:404-317-9134
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)